Conduit harvesting instrument and method

ABSTRACT

A surgical instrument for harvesting vessels from the body includes an elongated shaft ( 12 ) having distal and proximal ends and a plurality of lumens ( 150   a   , 150   b ) disposed therethrough. The shaft also includes a tip having a dissecting portion disposed at a distal end thereof and a cradle section ( 114 ). The tip is movable from a first position proximate the distal end of the shaft to at least one additional position distally further from the distal end of the shaft to expose the cradle section. The instrument also includes an endoscope ( 162 ) disposed in one of the plurality of lumens and at least one additional surgical instrument ( 132 ) disposed in one of the remaining lumens. Methods are disclosed for utilizing the surgical instrument.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit of and priority to U.S. ProvisionalPatent Application Ser. No. 60/301,059 entitled “CONDUIT HARVESTINGINSTRUMENT AND METHOD” filed on Jun. 26, 2001 by Hanspeter R. Bayer, theentire contents of which is hereby incorporated by reference herein.

BACKGROUND

1. Field of the Disclosure

This present disclosure relates to instruments and methods forperforming minimally invasive, laparoscopic or endoscopic surgicalprocedures. More particularly, the present disclosure relates toinstruments and methods that are especially suitable for procedures thatrequire or benefit from minimally invasive access to anatomical conduitsor vessels for harvesting the same. The instrument is suitable forharvesting vessels from surrounding tissue for use in bypass proceduresincluding, but not limited to, coronary artery bypass grafting (CABG) orreverse or in-situ femoral-popliteal or femoral-tibia peripheral bypassgrafting.

2. Related Art

Coronary artery disease is often characterized by, lesions or occlusionsin the coronary arteries which may result in inadequate blood flow tothe myocardium, or myocardial ischemia, which is typically responsiblefor such complications as angina pectoris, necrosis of cardiac tissue(myocardial infarction), and sudden death. In some cases, coronaryartery disease may be treated by the use of drugs and/or bymodifications in behavior and diet. In other cases, dilatation ofcoronary arteries may be achieved by such procedures as angioplasty,laser ablation, atherectomy, catheterization, and intravascular stents.Coronary bypass surgery is required when these methods of treatmentcannot be used or have failed to clear the blocked artery.

Many surgical procedures have been developed to replace arteries thathave come blocked by disease. For certain patients, a coronary arterybypass graft (“CABG”) is the preferred form of treatment to relievesymptoms and the graft often increases life expectancy. A CABG procedureconsists of direct anastomosis of a vessel segment to one or more of thecoronary arteries. For example, a reversed segment of the saphenous veinmay be grafted at one end to the ascending aorta as an arterial bloodsource and at the other end to a coronary artery at a point beyond thearterial occlusion.

Therefore and in order to perform a CABG procedure, a vessel must beharvested from the body and grafted into place on either side of thepoint of blockage. It is preferred to use a vein taken from the patientundergoing the bypass surgery to avoid and/or limit the chances ofrejection by the body after grafting onto the aorta and coronary artery.The saphenous vein in the leg is often the most suitable candidate foruse in coronary bypass surgery because the saphenous vein is typically 3mm to 5 mm in diameter which is about the same size as a coronaryartery. The cephalic vein in the arm is another suitable harvestingcandidate for CABG procedures.

As can be appreciated, harvesting these conduits from the body oftenrequires enormous skill and precision due to the delicate nature of thetissue structure. Various methods for harvesting vessels are known. Forexample, some surgeons typically cut the leg open and carefully dissectthe surrounding tissue from the vein using dissecting scissors or tissuescraping instruments. Other surgeons make a series of incisions from thegroin to the knee or the ankle leaving one or more skin bridges alongthe line of the incisions. The surgeon then literally strips the veinfree from surrounding tissue using one or more surgical dissectinginstruments.

While stripping the vein and removing the surround tissue, the surgeonwill undoubtedly encounter the various tributary veins that feed intothe saphenous vein. These tributaries must be ligated and separated fromthe vein prior to removal. As can be appreciated, ligating andseparating these tributaries from the vein requires a high degree ofskill and accuracy and is typically a very tedious procedure.

When the vein has been completely mobilized and the tributaries havebeen divided from the vein, the surgeon cuts the proximal and distalends of the vein and removes the vein from the leg. Once removed, thevein is prepared for implantation into the graft site, and the longincision(s) made in the leg are stitched closed.

The procedures described above are often used to harvest veins for afemoral popliteal bypass or for the revascularization of the superiormesenteric artery which supplies blood to the abdominal cavity andintestines. In addition, the above-described procedures can be used toharvest the umbilical vein or to harvest veins for femoral-tibial,femora-peroneal, aorto-femoral, and iliac-femoral bypass operations andany other bypass operation.

As can be appreciated from the above descriptions, the harvesting ofvessels can be very traumatic and is often the most troublesome part ofthe bypass operation. Moreover, the incisions, especially the long ones,created in the leg or arm to harvest the vessel tend to heal slowly andare often very painful.

Over the last several years, minimally invasive, for example endoscopictools and methods have been developed for harvesting vessels which areless intrusive and less traumatic. For example, with one knowntechnique, the surgeon makes a few small incisions in the leg andinserts one or more elongated surgical instruments, e.g., forceps,scissors, clip appliers, staplers, etc., into the incision and carefullymanipulates the instruments while viewing the operating area through anendoscopic or laparoscope. These techniques are often referred to asendoscopic, laparoscopic, minimally invasive, or video-assisted surgery.References to endoscopic surgery and endoscopes below is intended toencompass all these fields, and the exemplary operations described belowwith reference to endoscopes can also be accomplished with laparoscopes,gastroscopes, and any other imaging devices which may be convenientlyused.

Other minimally invasive procedures for vein harvesting are also known.For example, soviet patent number SU 1371689 teaches a vessel removalprocedure which utilizes an endoscope having a lumen extendingtherethrough. In this procedure, the saphenous vein is grasped and heldwith a grasper which is introduced through the lumen of the endoscope.After connective tissue has been dissected from around the vein, alength of the vein is ligated, transected and removed from the lowerlimb of the patient through the lumen of the endoscope. U.S. Pat. No.5,373,840 discloses a method for harvesting the saphenous vein whichalso utilizes an endoscope having a lumen disposed therethrough.

Other known techniques employ balloons which are inflated to create aworking cavity or tunnel along the length of the vein. For example, U.S.Pat. No. 5,601,581 describes a method of vein harvesting which utilizesan everted balloon to assist in dissecting the harvested vein. Theballoon is stored inside a cannula which is inserted through one of thesmall incisions in the leg and inflated so that it everts out the end ofthe cannula and forces its way along the vein to create a tunnel.

Typically, many of the above-described techniques require the surgeon toinsert different instruments through the working lumen of the endoscopeto dissect tissue and to separate vessel tributaries. As can beappreciated, this simply adds to the overall complexity of the operationsince it requires the repeated exchange of surgical instruments throughthe working lumen to perform the different tasks associated with bluntdissection and removal of the vessel tributaries.

Thus, a need exists to develop an endoscopic vessel harvestinginstrument and method for harvesting vessels which allows the operatorto both dissect surrounding tissue from the vein and selectivelymanipulate, grasp and separate vessel tributaries from the vein withoutremoving and/or exchanging instruments through the working lumen.

SUMMARY

The present disclosure relates to a surgical instrument for harvestingvessels which includes an elongated shaft having distal and proximalends and a plurality of lumens disposed through the shaft. The shaftpreferably includes a tip having a blunt dissecting portion disposed ata distal end of the shaft and a cradle section disposed between theblunt dissecting portion and the distal end of the shaft. Preferably,the tip is selectively movable from a first dissecting position whereinthe tip is proximate the distal end of the shaft to an expanded positiondistally further from the distal end of the shaft to expose the cradlesection. The instrument also includes an endoscope disposed in one ofthe plurality of lumens and at least one additional surgical instrumentdisposed in one of the remaining lumens.

Preferably, the dissecting portion is transparent and/or conical indimension to facilitate blunt dissection of surrounding tissue from thevessel. In one embodiment, the tip is extendable along a longitudinalaxis defined through the shaft to expose the cradle section.Advantageously, the cradle section includes a notched portion tofacilitate manipulation, orientation and positioning and securement of avessel tributary and to facilitate its ligation and/or separation fromthe main conduit vessel. The tip and/or the cradle section is preferablyrotatable about the endoscope to assist in the orientation of the cradlesection for and during manipulation and separation of the vesseltributaries 360° about the vessel. The tip and/or the cradle section canalso be selectively rotatable about the axis of the shaft

Additional instruments which can be disposed through one or more of theremaining lumens in the shaft can be selected from the group consistingof: ligating instruments, bipolar shears, ultrasonic shears, clipappliers, coagulating instruments, cutting instruments, vessel sealinginstruments, vessel graspers, irrigation instruments, insufflators,suction instruments and combinations of the same. It is envisioned thatthe additional instruments may be selectively extendable, retractableand/or rotatable relative to the instrument, shaft or endoscope tofacilitate operation thereof.

In one embodiment, the additional instrument is an electrosurgicalligating instrument which is remotely operated by an actuator, e.g., atrigger located adjacent the proximal end of the shaft or an actuatorremotely located for remote activation and/or manipulation of thetrigger or the actuator. Preferably, the trigger or actuator allows theoperator to selectively manipulate (i.e., extend and/or rotate) andactivate the ligating instrument as needed during ligation and/orseparation of the vessel tributaries and/or removal of the vessel fromthe body.

In another embodiment, the shaft, preferably a distal portion thereof,includes a balloon disposed about the outer periphery thereof and whichis selectively inflatable and/or deflatable. The balloon allows theoperator to grossly dissect surrounding tissue away from the vessel andcreate and/or maintain a working space between the vessel and thetissue. The working space may be insufflated as needed during theharvesting procedure to facilitate visualization and removal of thevessel.

Another embodiment of the present disclosure is a surgical instrumentfor dissecting a vessel from surrounding tissue which includes a housingand an elongated shaft preferably attached to the housing. The shaftincludes a plurality of lumens disposed at least partially therethrough.A blunt tip is disposed at a distal end of the shaft and is selectivelymovable by an actuator mounted to the housing. The actuator allows theoperator to extend the tip from a first dissecting position wherein thetip is positioned proximate the distal end of the shaft (i.e.,positioned to separate surrounding tissue from the vessel) to at leastone additional position distally further from the distal end of theshaft to expose a cradle section. An endoscope is disposed in at leastone of the lumens for visualization purposes and one or more additionalsurgical instrument(s) (preferably selected from the list mentionedabove) is disposed in one or more of the remaining lumens.

The actuator can include a ball-like mechanism which allows the operatorto selectively extend and/or rotate the blunt tip, cradle section and/orshaft for manipulating, positioning and separating vessel tributaries.

Another embodiment of the present disclosure includes an endoscopicvessel harvesting instrument having a housing with proximal and distalends and an elongated shaft attached to the housing, preferably itsdistal end. The shaft includes a tip integral with or slidingly attachedto a portion of the instrument and operative at or adjacent to thedistal end of the shaft. The shaft also includes a plurality of lumensdisposed at least partially through and in communication with the distalend of the shaft. Preferably each of the lumens is dimensioned toaccommodate one of a plurality of surgical instruments selected from thegroup consisting of: endoscopes, ligating instruments, bipolar shears,ultrasonic shears, clip appliers, coagulating instruments, cuttinginstruments, vessel sealing instruments, insufflators, vessel graspers,irrigation instruments, suction instruments and combinations of thesame. The endoscopic vessel harvesting instrument can include a balloonattached to an outer periphery of the shaft and an actuator engagablewith or engaged to one of the plurality of instruments for selectivelyoperating and/or manipulating one or more of the plurality ofinstruments relative to the shaft, axis or endoscope. An actuator isdisposed on the shaft, in the shaft housing or in the base housing forselectively operating and/or manipulating the tip and/or the cradlesection relative to the shaft, axis and/or endoscope. An inflation portcan also be included with the vessel harvesting instrument forselectively inflating the balloon for grossly or otherwise dissecting ordistancing surrounding tissue.

The present invention also relates to a method for harvesting a vesselfrom surrounding tissue. The method includes the steps of: providing asurgical instrument having a housing with distal and proximal ends. Thehousing can have an elongated shaft attached at a distal end thereofwhich includes a blunt tip and a plurality of lumens disposedtherethrough. Preferably, one of the lumens is dimensioned toaccommodate an endoscope and at least one of the remaining plurality oflumens is dimensioned to accommodate an additional surgical instrumentselected from the group consisting of: ligating instruments, bipolarinstruments, ultrasonic instruments, clip appliers, coagulatinginstrument, cutting instruments, vessel sealing instruments,insufflators, vessel graspers, irrigation instruments, suctioninstruments and/or combinations of the same. The tip is selectivelymovable to expose a cradle section between the tip and a distal end ofthe shaft.

The method can include the steps of: inserting the instrument into anincision in the body (either directly or through a cannula); advancingthe instrument through the incision and along the vessel; utilizing theendoscope to view the internal working space and the blunt tip todissect surrounding tissue from the vessel; selectively extending theblunt tip to expose the cradle section to position therein vesseltributaries for treatment (i.e., grasping, separating, dividing,ligating, occluding, cutting, etc.) by the additional one or moresurgical instruments; repeating the advancing and extending steps asneeded to clear surrounding tissue from the vessel and treat vesseltributaries; and removing the vessel from the body.

Before or after the extending step, the method may include the step of:rotating the blunt tip, and/or the cradle section to positiontributaries therein for treatment. The shaft of the providing step mayinclude a balloon attached to the outer periphery thereof and after theadvancing step, the method may include the step of: selectivelyinflating the balloon to further dissect surrounding tissue from thevessel to create a space between the vessel and surrounding tissue.Preferably, after the inflating step, the method includes the step of:insufflating the space between the vessel and surrounding tissue with agas.

The present disclosure also relates to a method for harvesting a vesselfrom surrounding tissue which includes the steps of: providing asurgical dissector having a housing with distal and proximal ends. Thehousing includes an elongated shaft attached at a distal end of thehousing which has a blunt tip and at least one lumen disposed thereinfor housing an endoscope. The tip is selectively extendable from theshaft to expose a cradle section for positioning and treatingtributaries of the vessel.

The method can also include the steps of: inserting the instrumentthrough an incision in the body; advancing the instrument through theincision and along the vessel utilizing the endoscope to view and/or theblunt tip to dissect surrounding tissue from the vessel; selectivelyextending the blunt tip to expose the cradle section and position avessel tributary; sealing and separating a portion of the tributary fromthe vessel; repeating the advancing, extending and treating steps asneeded to clear surrounding tissue from the vessel and/or seal orseparate additional vessel tributaries; and removing the vessel from thebody. Preferably, the advancing step is effected with the blunt tipretracted to reduce exposure of the cradle section. After the extendingstep, the method can further include the step of: rotating the cradlesection to position tributaries for treatment.

Other methods for harvesting a vessel from surrounding tissue includethe steps of: providing a surgical instrument having a housing includingdistal and proximal ends. The housing has an elongated shaft attached ata distal end thereof which includes a blunt tip, a cradle section and aplurality of lumens disposed therethrough. One of the lumens isdimensioned to accommodate an endoscope, and at least one of theremaining plurality of lumens is dimensioned to accommodate one of aplurality of additional surgical instruments selected from the groupconsisting of: ligating instruments, bipolar shears, ultrasonic shears,clip appliers, coagulating instruments, cutting instruments, vesselsealing instruments, vessel graspers, insufflators, irrigationinstruments, suction instruments and combinations of the same.Preferably, the tip is selectively movable to expose the cradle section,and the cradle section is located between the tip and a distal end ofthe shaft.

The method also includes the steps of inserting the instrument into anincision in the body; advancing the instrument distally through theincision and along the vessel with the cradle section unexposed; withthe cradle section unexposed, utilizing the endoscope to view and theblunt tip and/or the unexposed cradle section to dissect surroundingtissue from the vessel and form an operating cavity; selectivelyextending the blunt tip to expose the cradle section; withdrawing theinstrument in a proximal direction through the operating cavity andutilizing the exposed cradle section to position vessel tributaries fortreatment by one of the plurality of additional surgical instruments;and treating the vessel tributaries by use of the one of the pluralityof surgical instruments.

Still another method for harvesting a vessel from surrounding tissue,includes the steps of: providing a surgical dissector having a housingincluding distal and proximal ends. The housing has an elongated shaftextending from at a distal end of the housing. The shaft includes ablunt tip and at least one lumen disposed therethrough for housing anendoscope. The blunt tip is selectively extendable from the shaft toexpose a cradle section for positioning vessel tributaries.

The method also includes the step of: inserting the instrument into anincision in the body; advancing the instrument through the incision andalong the vessel utilizing the endoscope to view and the blunt tip todissect surrounding tissue from the vessel; selectively extending theblunt tip to expose the cradle section and position a vessel tributary;and separating the tributary from the vessel.

The method can comprise effective dissection while moving the instrumentdistally into and through the incision and along a main vessel and, withthe blunt tip retracted, dissecting tissue from the main vessel (andtributary vessel) and with the blunt tip still retracted, withdrawingthe instrument in the proximal direction; extending the blunt tipdistally away from the shaft to expose the cradle section; and advancingthe instrument in the distal direction with the blunt tip extended andcradling a tributary vessel and treating it with the additional one ormore surgical instrument housed in one or more of the lumens. Thetreating step can include ligating and transecting one or more tributaryvessel to free the main vessel from its tributary vessel to enable asection of the main vessel to be withdrawn from the incision.

In accordance with another method of the present disclosure, the methodfor harvesting can include the steps of: A method for harvesting avessel from surrounding tissue, comprising the step of: providing asurgical instrument having:

a housing including distal and proximal ends, the housing having anelongated shaft attached thereto and extending from a distal endthereof, the shaft including a blunt tip, a cradle section and aplurality of lumens disposed through at least portions of the shaft, oneof the lumens being dimensioned to accommodate an endoscope, and atleast one of the remaining plurality of lumens being dimensioned toaccommodate one of a plurality of additional surgical instrumentsselected from the group consisting of: ligating instruments, bipolarshears, ultrasonic shears, clip appliers, coagulating instruments,cutting instruments, vessel sealing instruments, vessel graspers,insufflators, irrigation instruments, suction instruments andcombinations of the same;

the tip being selectively distally extendible from a retracted positionto expose the cradle section, the cradle section being located betweenthe tip and a distal end of the shaft.

The method also includes the steps of:

inserting the instrument into an incision in the body;

advancing the instrument distally through the incision and along thevessel with the tip in a retracted position with the cradle sectionsubstantially unexposed;

utilizing the endoscope to view and the blunt tip to dissect surroundingtissue from the vessel to form an operating cavity;

retracting the instrument in a proximal direction toward the incision;

extending the blunt tip to expose the cradle section;

re-advancing the instrument distally through the incision and along thevessel with the cradle section exposed;

utilizing the exposed cradle section to successively position respectivevessel tributaries therein; and

treating the successive cradled vessel tributaries by use of the one ofthe plurality of additional surgical instruments.

BRIEF DESCRIPTION OF THE DRAWINGS

Other objects and features of the present disclosure will becomeapparent from the following detailed description considered inconnection with the accompanied drawings. It should be understood,however, that the drawings are designed for the purpose of illustrationonly and not as a definition of the limits of the invention.

An illustrative embodiment of the subject surgical instrument and methodare described herein with reference to the drawings wherein:

FIG. 1A is a perspective view of an endoscopic instrument for harvestingvessels according to the present disclosure which includes an elongatedshaft having a plurality of lumens disposed therethrough and a blunt tiplocated at a distal end thereof;

FIG. 1B is an enlarged, isolated view of a ball-like actuator whichmoves the blunt tip as needed for blunt dissection and ligation purposesand a trigger mechanism which moves and actuates a ligation instrument;

FIG. 2A is an enlarged, exploded perspective view with portions removedand portions broken away, of the blunt tip of the harvesting instrumentof FIG. 1 having a movable cradle section for handling vesseltributaries and showing an endoscope for viewing the surgical area andan instrument for ligating and cutting vessel tributaries;

FIG. 2B is a front view of an alternate embodiment of the elongatedshaft showing a cradle arm of the cradle section disposed in of aself-enclosed recess disposed radially inward of the outer periphery ofthe elongated shaft;

FIG. 2C is a front view of an alternate embodiment of the elongatedshaft showing the cradle arm of the cradle section disposed within arecess formed within the outer periphery of the elongated shaft and anouter tube which surrounds the shaft and the cradle arm to slidinglymaintain the cradle arm within the slot;

FIG. 3 is an enlarged, perspective view with portions removed andportions broken away, of the harvesting instrument of FIG. 1 showing theendoscope and the ligation and cutting instrument housed therein andillustrating the rotational and axial capabilities of the blunt tip,shaft and cradle portions relative to the endoscope;

FIG. 4 is a rear perspective view of the harvesting instrument of FIG.1.

FIG. 5 is a perspective view of the harvesting instrument with the blunttip in a retracted position for blunt dissection of the main vessel fromthe surrounding tissue;

FIG. 6 is a perspective view of the harvesting instrument showing theblunt tip in an extended position to position a vessel tributary andshowing a dissection balloon being inflated for grossly dissecting thesurrounding tissue from the vessel;

FIG. 7 is a perspective view of the harvesting instrument showing theblunt tip in an extended position and showing the ligation instrumentbeing extended toward the cradled vessel tributary;

FIG. 8 is a perspective view of the harvesting instrument showing theligation instrument ligating and cutting the vessel tributary from themain vessel;

FIG. 9 is a perspective view of the harvesting instrument showing theseparated vessel tributary outside of the cradle section;

FIG. 10 is a perspective view of another embodiment of the presentdisclosure wherein the shaft includes an additional lumen for housing anadditional instrument, e.g., an irrigation instrument for cleaning thelens of the endoscope;

FIG. 11 is a perspective view of another embodiment of the presentdisclosure wherein the shaft includes a plurality of the lumens forhousing additional surgical instruments therein;

FIG. 12A shows an alternate embodiment of the movable tip and cradlesection according to the present disclosure;

FIG. 12B shows an alternate embodiment of the movable tip and cradlesection according to the present disclosure

FIGS. 13-14 show alternate methods for slidingly engaging the cradle armto the outer periphery of the shaft;

FIG. 15 shows an alternate embodiment of an instrument of the presentinvention, with parts broken away;

FIG. 16 shows an alternate embodiment of a cradle section with aselectively removable tip according to the present disclosure; and

FIG. 17 shows an alternate embodiment of the cradle section with anindependently movable tip according to the present disclosure.

DETAILED DESCRIPTION

Referring now to FIGS. 1A-4, there is disclosed one embodiment of anendoscopic vessel harvesting instrument 10 that can be employed forharvesting vessels 200 (FIG. 5) for use, e.g., in bypass procedures, inparticular, coronary bypass procedures. Harvesting instrument 10includes a proximal end 15, a distal end 17 and an elongated shaft 12disposed therebetween, but not necessarily in direct communication withsuch ends 15 and 17. For the purposes herein, it is understood that FIG.1A discloses one embodiment of the presently disclosed instrument. Asdescribed in more detail below, it is envisioned that the instrument mayinclude a base housing which is integral with or attachable to a shafthousing and a shaft which is integral with or attachable to the shafthousing. In such instances, what is commonly termed the “proximal end”may change depending upon whether a single, integral, base housing isutilized or a combination base housing and shaft housing is utilized.

Elongated shaft 12 includes proximal and distal ends 16 a and 16 b,respectively, and is preferably dimensioned to fit in a 12 mm or 15 mmtrocar. A base housing 18 is disposed at or near the proximal end 15 ofthe instrument 10 and a preferably transparent, preferably conical bluntdissection tip 100 is extendibly disposed at the distal end 17 of theinstrument 10. The base housing 18 is designed to accommodate varioussurgical instruments (described in detail below) as well as facilitateremote operation of proximal portions of the harvesting instrument 10and its lumen-housed instruments directly or indirectly by the surgeonoutside the operating cavity. For the purposes herein, housing 18 may beintegral with shaft housing 18′ to define a single housing 18 or,alternatively, the shaft housing 18′ may be removably engaged with thehousing 18.

Elongated shaft 12 is dimensioned to fit through a cannula or trocarport 51 which can be inserted by the surgeon into an incision at theonset of the harvesting operation. Shaft 12 communicates with, extendsfrom and is attached to a shaft housing 18′ which is selectively engagedwith the base housing 18. The proximal end of the shaft 16 a can also beselectively engageable with the shaft housing 18′. The shaft 12 alsoincludes plurality of lumens, for example, 150 a-150 d (FIG. 11)extending or at least partially disposed therein or at least partiallytherethrough for housing various surgical instruments used in connectionwith harvesting the vessel 200. Preferably, the lumens can accommodateinstruments approximately 5 mm to 7 mm in width. For example and as bestillustrated in FIGS. 2 and 3, the shaft 12 includes a first lumen 150 awhich can house an endoscope 162 for observing or visualizing theoperating cavity 400 (FIG. 5) during dissection of the surroundingtissue 300 and ligation and/or transection of the tributary branches ofthe vessels (explained in more detail below with respect to theoperation of the instrument). Preferably, endoscope 162 is constructedto be part of instrument 10. Shaft 12 also includes a second lumen 150 bfor housing an additional surgical instrument, here a ligating/cuttinginstrument 132, hereinafter sometimes referred to simply as a ligatingor ligation instrument, such as the TRIMAX™ instrument manufactured byUnited States Surgical, a division of Tyco Healthcare Group LP ofNorwalk, Conn.

Preferably, ligation instrument 132 is constructed as part of instrumentand preferably ligation instrument 132 is selectively axially extendablefrom the lumen as best shown in FIGS. 3 and 7 and as described in moredetail below. Other suitable desired instruments may be housed in lumens150 a and/or 150 b, and additional instruments may also be housed withinone or more additional lumens, e.g., 150 c, 150 d which may be utilizedfor dissection and/or ligation, cauterization or other purposes (seeFIGS. 10 and 11). Ligating instrument 132 can, and preferably doesinclude a mechanical or electromechanical edge for cutting ortransecting vessel tributaries 210. Each lumen, e.g., 150 a, preferablyis dimensioned and/or includes or has an associated gasket, o-ring orother sealing component, e.g., grease, to maintain a tight, gaseous sealbetween the lumen-housed instruments and the inner periphery of thehoused instrument's lumen, e.g., 150 a.

Shaft 12 extends distally from a distal end 14 of the shaft housing 18′and is dimensioned to sealingly slide (see FIG. 1A) and/or rotate withinthe trocar port 51 or a trocar during blunt dissection as described inmore detail below. It is envisioned that the shaft 12 may be integralwith, pass through or be selectively engageable with shaft housing 18′and/or the base housing 18 depending upon the particular configurationsor purpose(s) of instruments 10. A balloon-like seal 52 can be coupledto the trocar port 51 for disposition inside and against a minimallyinvasive incision and to cooperate with a sponge-like stop member 50disposed at a proximal end 16 a of the shaft 12 exterior of and againstthe incision to limit or regulate the distal movement of the shaft 12(and/or seal the shaft) within the trocar port 51, and/or within theminimally invasive incision through which the instrument is at leastinitially employed.

As can be appreciated, the position of balloon seal 52 and stop member50 and/or the length of the shaft 12 may be sized or adjusted prior tothe harvesting operation such that the position of the stop member 50 onthe shaft 12 corresponds to the desired length of vessel 200 to beharvested, i.e., when the stop member 50 abuts against the balloon seal52, the surgeon has successfully dissected the appropriate amount ofsurrounding tissue 300 and removed enough tributary branches 210 fromthe vessel 200 for safe and facile removal of the desired length of thevessel 200 from the operating cavity. Moreover and as mentioned above,differently-sized shafts 12 may be selectively engaged with the shafthousing 18′ to ensure that the proper length of vessel 200 will beharvested.

Base housing 18 can include a proximal end 13 which includes a cavity 13a for housing a camera 166 which electronically couples to the endoscope162 for viewing tissue, operating cavity 400, vessel 200 and/or vesseltributaries 210. Endoscope 162 may also include a strain relief member160 which protects the endoscope from damage during use. It isenvisioned that the camera 166 may be connected to a monitor (not shown)to enhance display of operating cavity 400, etc. Base housing 18 alsoincludes an inflation port 70 which by suitable channel or port means isin communication with the balloon 40 and which allows the user toselectively inflate and deflate a balloon 40 disposed along the outerperiphery of shaft 12 preferably towards the distal end, to grosslydissect surrounding tissue 300 from vessel 200 (see FIGS. 4 and 5).Selective inflation of the balloon 40 also forms the operating cavity400 which may be insufflated with a fluid or gas to facilitate viewingof tissue, operating cavity 400, vessel 200 and vessel tributarybranches 210. Preferably, balloon 40 is seated within a recess 43disposed about the outer periphery of shaft 12. Incorporating theballoon 40 is optional and other known cooperative mechanisms forgrossly or otherwise dissecting the operating area are also envisioned.

The shaft housing 18′ includes an actuator, e.g., 30 a or 30 b and anactuator, for example, a trigger mechanism 130 a or 130 b (FIG. 1B)which controls the various instruments used for dissection. Actuator 30a (or 30 b) allows the user to selectively extend and retract tip 100 asneeded for blunt dissection of the vessel 200 from the surroundingtissue 300 and for cradling, orienting and facilitating ligation,transection and/or removal of tributary branches 210. In the embodimentof FIG. 1A, the actuator 30 a includes a toggle 31 a which simplypermits axial translation of the tip 100 as needed for cradling, bluntdissection and separation of vessel tributaries 210. FIG. 1B shows analternative embodiment of the actuator, 30 b, which includes a ball-liketoggle member 31 b which allows both axial translation and rotation ofthe shaft 12 and tip 100 including cradle section 114 (see FIG. 4.) asneeded 360° for blunt dissection of tissue and ligation and separationof vessel tributaries 210.

Trigger mechanism 130 a (130 b) allow the user to selectively activatethe electrosurgical ligating instrument 132 for ligating and cutting thetributary branches 210 from the vessel 200. Trigger 130 a or 130 b iselectrically coupled to an electrosurgical generator (not shown) by acable 80 which supplies electrosurgical energy to the ligatinginstrument 132. One embodiment of the trigger 130 a, as best illustratedin FIGS. 1A and 3, includes first and second handles 136 and 138,respectively, which are axially moved within a slot 135 a disposed inthe shaft housing 18′ to extend (or retract) the ligating instrumentdistally. Simultaneously (or previously or subsequently) the handles 136and 138 may be actuated, i.e., “squeezed”, to move a pair ofelectrosurgical jaw members 134 a and 134 b relative to one another tograsp and ligate a vessel tributary 210. Electrosurgical energy isapplied to the jaw members 134 a and 134 b to ligate, and a knife bladeor energy is applied between the ligated portions to cut the vesseltributary 210 from the vessel 200. It is envisioned that theelectrosurgical ligating instrument 132 may be activated upon initial“squeezing” of either or both two jaw members 134 a and 134 b or by aseparate electrical switch, e.g., a “footswitch”, depending upon aparticular purpose. It is also envisioned that the “squeezing” of thehandles 136 and 138 may perform a dual function, e.g., operate thegrasping and cutting components of the TRIMAX™. For example, the initialsqueeze of the handles 136 and 138 cooperate to grasp and ligate in twoseparate areas the vessel 200 between the ligated portions and continuedsqueezing reciprocates a knife to cut the vessel 200. An electrosurgicalactuator, i.e., switch (not shown), may also be employed on the triggerassembly 130 a. It is envisioned that an actuator (not shown) may beincluded with the housing 18 and/or the shaft housing 18′ to rotate theshaft 12 relative to the endoscope or about the longitudinal.

An alternate embodiment of trigger mechanism 130 a is adapted to permitselective axial translation and/or rotation of the ligating instrument132 as needed for approximating, positioning, ligating and cutting thevessel tributaries 210. For example, FIG. 1B shows an elongated andvertically spaced slot 135 b which permits the user to axially translatethe handles 136 and 138 to extend or retract the jaw members 134 a and134 b and also permits the user to simultaneously or otherwise rotatethe handles 136 and 138 to rotate the ligating instrument 132 as neededfor separation of the vessel tributaries 210. More detail with respectto this aspect of operation of the ligating instrument 132 is explainedbelow with respect to FIGS. 5-9.

It is envisioned that additional surgical instruments may be utilizedwith the present disclosure which may be controlled from the shafthousing 18′ (or base housing 18) or separate remote control box (notshown). For example, graspers, irrigation devices, e.g., nozzles andsprayers (see FIG. 10), suction instruments, clip appliers, bipolar ormonopolar instruments, scissors, insufflators, vessel sealinginstruments, etc., may incorporated with the instrument 10 andoperated/controlled from shaft housing 18′ a separate and/or remotehousing or control box (not shown). Lumens can be provided through theshaft 12 and/or tip 100 to accommodate one or more of these additionalinstruments (see FIG. 11).

As mentioned above, the distal end 16 b of the shaft 12 includes aneccentrically, conically-shaped, blunt tip 100 which is preferablytransparent for visualization of the working cavity 400. It isenvisioned that the presently disclosed design of the tip 100 providesthe surgeon with the following advantages: 1) the blunt-like dimensionsof the tip 100 enable the surgeon to dissect tissue 300 away from thevessel 200 without causing trauma to the vessel 200 or the surroundingtissue 300; 2) the transparent aspects of the tip 100 provide clearvisualization of the surrounding operating cavity 400 with the endoscope162 during blunt dissection of the vessel 200, during cradling,orientation and ligation of the tributary branches 210; and 3) the tip100 is selectively extendable and retractable to expose the cradlesection for positioning, cradling, grasping, trapping, engulfing and/orlocalizing vessel tributary branches 210 which need to be separated fromthe vessel 200 prior to removal. The eccentric design and location ofthe nose of the tip 100 close to the outer periphery of blunt tip 100allows the nose to dissect tissue 300 that is located close to thevessel 100. Rotation of the instrument 10 about vessel 1000 permitsclose dissection 360° about the vessel.

As shown best in FIG. 3, the blunt tip 100 is preferably aligned withand rotatable about the endoscope 162 to provide optimal visualizationof the blunt tip 100 in the operating cavity as the blunt tip 100engages tissue 300 and vessel tributary branches 210. In one preferredembodiment, the blunt tip is rotatable but is continuously axiallyaligned with the endoscope to provide optimal viewing of the vessels,operating cavity and cutting cavity. It is also envisioned that, blunttip 100 can be selectively extended or retracted along and/or rotatedabout a longitudinal axis “A” defined through shaft 12, as bestillustrated in FIGS. 3 and 4. As can be appreciated, this gives thesurgeon even more control during dissection and while cradling andpositioning vessel tributaries 210. Moreover, blunt tip 100 includes anotched portion 120 which is dimensioned to both facilitate cradling,orientation and positioning or grasping of vessel tributaries 210 and tolikewise facilitate securing vessel tributaries 210 during ligation (seeFIGS. 6-9).

Turning now to the operation of the harvesting instrument 10 as bestseen in FIGS. 5-9, the instrument 10 is initially introduced into anincision though a trocar or cannular port 51 with the blunt tip 100disposed in a retracted, preferably fully retracted, position. Endoscope162 is retracted, i.e., not extended beyond the distal end 16 b of shaft12, and ligating instrument 132 is preferably at least partiallyretracted. The tissue 300 surrounding the vessel 200 to be harvested isinitially dissected and cleared utilizing the blunt tip 100 as theinstrument 10 is manually inserted and manipulated within the port 51.It is envisioned that the surgeon delicately dissects the surroundingtissue 300 from the vessel 200 by manipulating and rotating instrument10, shaft 12, tip 100 and/or cradle section 114 either manually orutilizing the ball-like slide 31 b (or other type of actuator)identified in FIG. 1B. Once the portion of the vessel 200 is dissectedfrom the immediate surrounding tissue 300, the surgeon then selectivelyinflates the balloon 40 to grossly dissect the surrounding tissue 300from the vessel 200 (FIG. 6). This creates and helps to maintain anoperating cavity 400 between the vessel 200 and the surrounding tissue300 thereby exposing attached vessel tributaries 210.

As can be appreciated, the transparency or transparent aspects of thetip 100 allow clear visualization of the operating cavity 400, thevessel 200 and vessel branches 210 through the tip 100. At this point,the surgeon may insufflate the cavity 400 through, e.g., lumen 150 d,with a gas utilizing an insulation port (not shown) which may be coupledto the trocar port 51 or located independently within operating cavity400. As mentioned above, the balloon-like seal 52 (FIG. 1) maintains thecavity 400 in an extended configuration to facilitate viewing, and helpsto seal the incision through which the trocar or cannula and instrument10 are inserted.

Once a vessel tributary branch 210 is observed or identified, the tip100 is extended and manipulated manually or by actuating the actuator 30a (or 30 b) to expose a cradle section 114 which traps, partiallyengulfs, grasps, positions, orients and secures the vessel tributary 210as best seen in FIGS. 6 and 7. Preferably, the cradle section 114includes a cradle arm or extension 121 which is disposed in a recesswithin the outer periphery of the shaft 12 (See FIG. 2B). As can beappreciated, the activation of the actuator 30 a or 30 b remotely(outside the incision) extends or retracts the cradle arm 121 which, inturn, deploys or retracts the cradle section 114.

In a preferred embodiment according to the present disclosure, an openslot or recess 122 is disposed about the outer periphery of the shaft12. An outer tube 47 (see FIG. 2C) acts to slidingly, sealingly maintainthe cradle arm 121 in position with the slot 122 during extension andretraction of the cradle section 114. Alternatively, the outer tube 47and the cradle section 114 may be integrally associated with one anothersuch that selective movement of the tube 47 relative to the shaft 12deploys and selectively moves the cradle section 114. As can beappreciated, no recess is needed within the outer periphery of the shaft12 in this latter embodiment since the tube 47 and the cradle section114 move with one another. Again, a gasket or lubricant may be employedbetween the shaft 12 and the tube 47 to provide a tight gaseous seal.Other seals (or the like) may also be used between additionalinstruments or components depending upon the particular embodiment,e.g., the shaft 12 and tube 47, or the shaft 12 and tube 47 and cannula51.

In the embodiment shown in FIG. 2B, the cradle arm 121 is disposedwithin a self-enclosed slot 122 disposed near the outer periphery ofshaft 12. Slot 122 may include a v-shaped cross section, u-shaped crosssection, dove tail cross section or any other configuration to provide acontrolled location and facilitate relative movement of the cradle armwithin the slot 122. Moreover, the mechanical engagement of the cradlearm 121 within the slot 122 is preferably a tight, slip-friction fit toprovide a gaseous seal. Additional components may also be included toenhance the gaseous seal, e.g., gasket(s), o-ring(s) and/or grease-likesealing lubricants. Moreover, the distal end 16 b of the shaft 12 mayinclude one or more of the above-identified sealing components tofurther promote a gaseous seal. For example, an o-ring type seal 57 maybe attached to the proximal end of the cradle arm 121 to provide gaseoussealing between the cradle arm 121 and the outer periphery of the shaft12.

The extension of the cradle section 114 exposes a gap or cutting cavity125 between the cradle section 114 and the distal end 16 b of the shaft12. The cutting cavity 125 extends from a concave area or hollow 137inside the blunt tip 100 to but preferably not through the distal end 16of the shaft 12. This enables the ligating and/or cutting instrument (orother one of the plurality of instruments) to extend beyond the vesseltributary for positioning, manipulating and ligating/transecting orotherwise treating a vessel. In addition, the concave area 137 insidethe blunt tip 100 may also be dimensioned to house the or a distal endor end portion of the additional instrument when the tip 100 isunexposed or fully retracted.

It is envisioned that the cradle section 114 may be operativelyassociated with a remote actuator, e.g., 31 b, to allow selectivemovement along, and if desired, rotation of the cradle section 114 abouta longitudinal axis of the instrument 10. In this embodiment, the tip100, cradle section 114 and shaft 12 would rotate independently of andabout the endoscope 162 (i.e., the endoscope 162 remains fixed) whichallows the user to maintain a clear view of the working area and cuttingcavity 125 throughout 360° of rotation of the cradle section 114 andshaft 12. Alternatively but less desirably, the cradle arm 121 may befixed against rotation to prevent rotation of the cradle section 114relative to the viewing lens 164 of the endoscope 162.

The user then employs the trigger 130 a (or 130 b) to extend and/orrotate the ligating instrument 132 into the cutting cavity 125 andmanipulates trigger handles 136 and 138 to grasp and secure the vesselbranch 210 between the jaw members 134 a and 134 b (FIG. 8). Preferably,the ligating instrument 132 is selectively rotatable within itsrespective lumen 150 b to facilitate use of the instrument relative tothe vessels or branches.

As can be appreciated, the endoscope 162 provides a clear view of thecutting cavity 125 and vessel tributaries 210 to assure consistent andaccurate manipulation of the jaw members 134 a and 134 b about aparticular tributary branch 210. A light may also be employed with theendoscopic lens to illuminate the operating cavity and cutting cavity tofacilitate dissection and harvesting. Preferably, the endoscope isoriented or adapted to view the working area and in some circumstancesit may be desirable to orient the endoscope at an angle relative to theworking area to enhance viewing. Electrosurgical energy is then appliedto cut the vessel branch 210 from the vessel 200.

In a preferred embodiment, for viewing the arms of the ligatinginstrument, the endoscope 162 is directed or focused downward at antangle of about 30°. Alternatively, the endoscope may also be providedat a flat angle, i.e., 0° degrees, to enable a wider view of theoperating area. It is envisioned that the instrument 10 may include afocusing lens which enables the surgeon to selectively orient or focusthe endoscope 162 depending upon a particular purpose.

Since jaw members 134 a and 134 b of the ligating instrument 132 arepositioned a predetermined distance “AA” from the outer periphery ofshaft 12 and, hence, from vessel 200, controlled, consistent andaccurate ligations, transections and lengths and separations of thetributary 210 from the remaining branch vessel 210′ are obtained withoutcompromising the integrity or strength of vessel 200. This minimizescontact between instrument 10 and vessel 200 and controls and minimizesthe amount of energy absorbed by vessel 200. Also, each remainingtributary branch 210 360° about the vessel 200 will be the same distance“AA” from main vessel 200. Once the tributary branch 210 is separated,the ligating instrument 132 and/or blunt tip 100 may, but need not be,be retracted (or retracted and extended as needed) to permit subsequentdissection of the remaining vessel 200 from the surrounding tissue 300(FIG. 9).

As mentioned above, the shaft may include additional lumens 150 c and150 d which can house additional surgical instruments, for example, fordissection of the surrounding tissue 300 and for removal of the branchtributaries 210. For example, FIG. 10 shows an irrigation nozzle 170disposed in lumen 150 c which may be selectively deployed to eject fluidtherefrom to clean/clear operating fluids or debris from the endoscopiclens 164. This assures clear continual visualization of the operatingcavity 400 and cutting cavity 125 without removal of the endoscope 162for cleaning purposes. Other instruments may also be selectivelyutilized to facilitate dissection of the vessel 200 and/or separation ofthe vessel branches 210, e.g., suction instruments, clip appliers,scissors (mechanical, bipolar, ultrasonic, etc.) shears, insufflators,bipolar or ultrasonic vessel sealing instruments, etc. One lumen can beused as a channel member for passage of a fluid (gas or liquid) toinflate and/or deflate one or more balloons which may be employed tofacilitate dissection and harvesting of the vessel 200.

FIG. 12A shows another embodiment of a cradle arm, here designated 421,which is operatively associated with actuator 30 a (or 30 b) for exampleby utilizing rod member 422 which is recessed within an elongatedslot-like depression 423 disposed about the outer periphery of theshaft. By actuating the actuator 30 a (or 30 b), the user canselectively expose and retract the cradle section 414 and tip 410 asneeded during dissection and harvesting. This embodiment may alsoprovide the user with the additional option of off-set rotation of thecradle section 414 relative to the shaft 12 which may prove useful fordissection purposes.

As best shown in FIG. 12B, the tip 810 and/or cradle section 814 mayinclude an arm or extension 821 coupled to a tube-like proximal portionor arm 847 which partly surrounds shaft 12. The tube-like proximalportion mechanically couples to the actuator 30 a to enable selectiveextension, retraction and/or rotation of the cradle section 814 and tip810.

FIGS. 13-15 show alternate embodiments of the cradle arm 521 slidinglyengaged within a recess or slot in shaft 12. FIG. 13 shows oneembodiment wherein the cradle arm 521 includes a dove-tail cross sectionwhich mates with a corresponding recess 522 disposed within the outerperiphery of shaft 12. As can be appreciated, the dove-tail crosssection by design constrains the cradle arm 521 within the recess 522without requiring an outer tube or sleeve to keep the arm seatedtherewithin. Suitable sealing means are employed to provide a gaseousseal between cradle arm 521 and recess 522.

FIG. 14 shows yet another embodiment for seating the cradle arm withinthe outer periphery of the shaft 12. A seal, here a gasket 657 isincluded to provide a gaseous seal between the shaft 12 and the tube647. A rubber flange 631 may also be included about the inner peripheryof the corresponding seal recess 623 to maintain the cradle arm intight, slip-friction engagement during extension and retracting of thecradle arm. Further, a plug 660 may also be included to compress theseal 657 against the distal end of the shaft 12 to maintain gaseousintegrity. In this and other embodiments, when a short tube 47 or 647 isemployed, the tube may be seated and held or affixed if desired, withinthe reduced diameter distal end portion of shaft 12 against step 662 toprovide a uniform diameter with the larger diameter of shaft 12.

FIG. 15 shows still another embodiment wherein the cradle arm 721 isgenerally rectilinear and slideably engages a corresponding recessdisposed in the distal end of the shaft. As can be appreciated, therectilinear design of the cradle arm 721 prevents rotation of the cradlearm 721 relative to the distal end of the shaft 12 and the endoscope(not shown) to avoid possibly obstructing the cutting cavity 725. A pairof alignment tabs 755 a, 755 b may also be included to facilitatealignment of the cradle section 714 when fully retracted against thedistal end of the shaft 12. Tabs 755 a, 755 b when seated in the cut outportions of the cradle help to keep tissue and debris from falling intothe working cavity between the distal face of shaft 12 and cradlesection 714.

The present disclosure also relates to a method for harvesting a vessel200 from surrounding tissue 300. The method includes the steps of:providing a surgical instrument 10 having a shaft housing 18′ includingdistal and proximal ends 14 and 13, respectively. The housing 18′ alsoincludes an elongated shaft 12 attached at or extending from the distalend 14 which includes a blunt tip 100 and a plurality of lumens, e.g.,150 a-150 d disposed therethrough. Preferably, one of the lumens 150 ais dimensioned to accommodate an endoscope 162 and one of the remainingplurality of lumens, e.g., 150 b is dimensioned to accommodate one of aplurality of additional surgical instruments selected from the groupconsisting of: ligating instruments, bipolar instrument, ultrasonicinstruments, clip appliers, coagulating instruments, cuttinginstruments, vessel sealing instruments, vessel graspers, insufflators,irrigation instruments and suction instruments. Blunt tip 100 isselectively movable to expose a cradle section 114 between the tip 100and a distal end 16 b of the shaft 12. Preferably, endoscope 162 andligating/transecting instrument 132 are provided as part of instrument10. The method can include providing a cannula or elongated sheath forhousing therein the extendable and retractable shaft 12 or cradle arm121 that includes blunt tip 100 and cradle 114. The endoscope andligating instrument may be sold separately apart from the instrument 10.

The method of the present disclosure can comprise the steps of:inserting the instrument 10 into an incision in the body; advancing theinstrument 10 through the incision and along the vessel 200; utilizingthe endoscope 162 to view and blunt tip 100 to dissect surroundingtissue 300 from the vessel 200 and form an operating cavity; selectivelyextending the blunt tip 100 to dissect tissue and/or to expose thecradle section 114 to position, cradle or secure vessel tributaries 210for treatment, e.g., ligation and transection by one or more of theadditional surgical instruments; repeating the advancing and/orextending steps as needed to clear surrounding tissue 300 from thevessel 200 and treat vessel tributaries 210; and removing the vessel 200from the operating cavity 400.

Dissection (preferably with the tip 100 retracted) can be performedwhile or in the process of moving the instrument 10 distally to effectand complete dissection in the distal direction, and vessel tributarytreatment, e.g., ligation and transection, can be effected (preferablywith the tip in the selectively extended position) while intermittentlyor otherwise moving or withdrawing the instrument and/or cradle 114 inthe proximal direction.

Before or after the extending step, the method may include the step of:rotating the blunt tip 100 and cradle section 114 to positiontributaries 210 for treatment. Preferably, the tip 100, the cradlesection and the shaft including the ligating instrument are rotatedabout the endoscope 162. The shaft 12 of the providing step may includea balloon 40 attached to the outer periphery thereof, e.g., in a recessin the outer surface of shaft 12, or tube 47, and after the insertionstep, the method may include the step of: selectively inflating theballoon 40 to further dissect surrounding tissue 300 from the vessel 200to create a space 400 between the vessel 200 and surrounding tissue 300.Preferably, after the inflating step, the method includes the step of:insufflating the space 400 between the vessel 200 and surrounding tissue300 with a fluid or gas.

The present disclosure also relates to a method for harvesting a vessel200 from surrounding tissue 300 which includes the steps of: providing asurgical dissector 10 having a housing 18 or 18′ in each case withdistal and proximal ends (as mentioned above, housing 18 may be integralwith shaft housing 18′ or, alternatively, the shaft housing 18′ may bethe proximal end of instrument 10 and may be removably engaged with thehousing 18). In such latter instance, the housing 18 would include anelongated shaft 12 supported by and attached at and/or extendingdistally from a distal end 14 of the overall housing 18 and 18′ andwhich has a blunt tip 100 and at least one lumen 150 a disposed thereinfor housing an endoscope 162. The tip 100 is selectively extendable fromthe shaft 12 to expose a cradle section 114 for positioning tributaries210 of the vessel 200.

The method can include the steps of: inserting the instrument 10 into anincision in the body; advancing the instrument 10 through the incisionand along the vessel 200 utilizing the endoscope 162 to view and theblunt tip 100 to dissect surrounding tissue 300 from the vessel 200;selectively extending the blunt tip 100 to expose the cradle section 114and position a vessel tributary 210 thereon; and treating the vesseltributaries by utilizing one of the plurality of surgical instruments.

Additional steps of the method may include: repeating the advancing andextending steps as needed to clear surrounding tissue 300 from thevessel 200 and separate additional vessel tributaries 210; and removingthe vessel 200 from the body.

Preferably, after the extending step, the method further includes thestep of: rotating the blunt tip 100 and the cradle section 114 toposition and orient vessel tributaries 210 for treatment.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the present disclosure. For example, it is contemplated that thepresently disclosed instrument 10 may include a disposable shaft 12which is selectively operatively engageable with the shaft housing 18′(or base housing 18 if integral with shaft housing 18′) and/or adisposable tip 100 (with or without a cradle) which is selectivelyoperatively engageable with the distal end 16 b of the shaft 12.Moreover, the instrument 10 may utilize either electrosurgical cuttinginstruments or non-electrical cutting instruments to separate the vesselbranches 210 from the vessel 200 depending upon a particular purpose orto achieve a particular result, e.g., scissors.

It is envisioned that the instrument may be designed such that the blunttip 910 is removably engageable with the cradle section 914 thusallowing a surgeon to selectively engage variously-sized andvariously-shaped tips for dissection purposes (See FIG. 16). Moreover,the instrument may be designed such that the blunt tip 1010 isindependently operable, i.e., extendible, retractable and/or rotatablevia arm 1021, relative to the cradle section 1014 (See FIG. 17).

Whether instrument 10 comprises its components extending distally fromthe proximal end of shaft housing 18′ apart from or connected to or aspart of the structure located proximally of the proximal end of shafthousing 18′, preferably the aforementioned components excludingendoscope 162 are rotatable about the endoscope, and the endoscope andaforementioned structure is not rotatable.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of preferred embodiments. Those skilled in the art willenvision other modifications within the scope and spirit of the claimsappended hereto.

1. A surgical instrument for harvesting vessels, comprising: anelongated shaft having a distal end and a proximal end and a pluralityof lumens disposed therethrough; a tip located at the distal end of theshaft, said tip including a dissecting portion disposed at a distal endthereof and a notched portion integrally formed therein at a proximalend thereof, said tip being in axial alignment with the longitudinalaxis of the shaft and movable from a first position proximate saiddistal end of said shaft to at least one additional position distallyfurther from said first position proximate said distal end of said shaftto expose a cradle section, said notched portion oriented transverselyto the longitudinal axis of the shaft and extending through acircumferential wall of the tip; and an endoscope disposed in one ofsaid plurality of said lumens, at least one of said remaining pluralityof said lumens being for housing at least one additional surgicalinstrument.
 2. A surgical instrument according to claim 1 wherein saidnotched portion defines a cradle that faces proximally of the surgicalinstrument.
 3. A surgical instrument according to claim 2 wherein saidshaft includes a longitudinal axis and said tip includes a nose which isgenerally eccentric relative to the longitudinal axis of the shaft.
 4. Asurgical instrument according to claim 1 wherein said tip issubstantially transparent.
 5. A surgical instrument according to claim 1wherein said tip is selectively, slideably distally extendable relativeto said distal end of said shaft to expose said cradle section.
 6. Asurgical instrument according to claim 1 wherein said tip is retractableproximally from said at least one additional position.
 7. A surgicalinstrument according to claim 1 wherein said tip and said shaft rotaterelative to said endoscope.
 8. A surgical instrument according to claim1 wherein said distal end of said tip is conical and substantiallyblunt.
 9. A surgical instrument according to claim 1 wherein saidendoscope is integrally associated with said instrument.
 10. A surgicalinstrument according to claim 1 wherein said notched portion is adaptedto operably engage vessel tributaries.
 11. A surgical instrumentaccording to claim 1 wherein said at least one additional instrument ishoused in at least one of said remaining plurality of lumens and isselected from the group consisting of: ligating instruments, bipolarshears, ultrasonic shears, clip appliers, coagulating instruments,insufflators, cutting instruments, vessel sealing instruments, vesselgraspers, irrigation instruments, suction instruments, and combinationsof the same.
 12. A surgical instrument according to claim 11 whereinsaid at least one additional surgical instrument includes a ligatinginstrument.
 13. A surgical instrument according to claim 12 wherein saidadditional instrument is housed in at least one of said remainingplurality of lumens and is integrally associated with the surgicalinstrument.
 14. A surgical instrument according to claim 12 wherein saidligating instrument is a ligating transecting instrument.
 15. A surgicalinstrument according to claim 14 wherein said ligating instrument isintegrally associated with the surgical instrument and is selectivelyextendable from the distal end of said shaft.
 16. A surgical instrumentaccording to claim 12 wherein said ligating instrument is selectivelyrotatable relative to said shaft.
 17. A surgical instrument according toclaim 11 wherein said additional instrument is remotely activated by anactuator.
 18. A surgical instrument according to claim 1 wherein saidadditional instrument is an electrosurgical ligating instrument and ishoused in one of said reaming additional lumens.
 19. A surgicalinstrument according to claim 1 wherein said surgical instrumentincludes a base housing and said shaft selectively engages said basehousing.
 20. A surgical instrument according to claim 1 wherein saidshaft includes a balloon disposed about an outer periphery thereof. 21.A surgical instrument according to claim 20 wherein said balloon islocated near said distal end of said shaft.
 22. A surgical instrumentaccording to claim 20 wherein said balloon is selectively inflatable.23. A surgical instrument according to claim 20 further comprising ashaft housing including an actuator for selectively inflating saidballoon.
 24. A surgical instrument according to claim 1, furthercomprising: a housing having the elongated shaft attached thereto andextending from a distal end thereof; and an actuator mounted to saidinstrument, said actuator being operable to extend said tip.
 25. Asurgical instrument according to claim 24 wherein said shah includes alongitudinal axis disposed therethrough and said actuator allows a userto selectively extend said tip distally along or parallel to saidlongitudinal axis and/or rotate said tip relative to said endoscope. 26.A surgical instrument according to claim 24 wherein said actuator alsoallows a user to selectively retract said tip proximally along orparallel to said longitudinal axis and/or rotate said tip relative tosaid endoscope.
 27. A surgical instrument according to claim 24 whereinsaid actuator is substantially ball-like.
 28. A surgical instrumentaccording to claim 24, further comprising an electrosurgical ligatinginstrument selectively extendable from the distal end of said shaft. 29.A surgical instrument according to claim 24, further comprising anelectrosurgical ligating instrument selectively rotatable relative tosaid shaft.
 30. A surgical instrument according to claim 28 or 29,wherein said electrosurgical ligating instrument is positioned to ligatetributaries at a predetermined distance from an upper surface of theshaft.
 31. A surgical instrument according to claim 24 wherein saidhousing is a shaft housing and said surgical instrument includes a basehousing located proximally from said shaft housing and said shaft isselectively engageable with said base housing.
 32. A surgical instrumentaccording to claim 24 wherein at least a portion of said tip istransparent.
 33. A surgical instrument according to claim 24 wherein atleast one of said plurality of remaining lumens includes an irrigationinstrument for irrigating and cleaning at least one of said tip and saidendoscope.
 34. An endoscopic vessel harvesting instrument, comprising: ahousing having proximal and distal ends; longitudinal axis of the shaftand extending through a circumferential wall of the tip, each of saidlumens dimensioned to said housing and having a tip slidingly attachedthereto, said shaft including a plurality of lumens being disposedtherethrough, said tip having a notched portion integrally formedtherein at a proximal end thereof, said tip being in axial alignmentwith the longitudinal axis of the shaft, said notched portion orientedtransversely to the longitudinal axis of the shaft, each of said lumensdimensioned to accommodate one of a plurality of surgical instrumentselected from the group consisting of: endoscopes, ligating instruments,bipolar shears, ultrasonic shears, clip appliers, coagulatinginstrument, cutting instruments, vessel scaling instruments, vesselgraspers, insufflators, irrigation instruments, suction instruments andcombinations of the same; a balloon attached to an outer periphery ofsaid shaft; at least one actuator engaged to at least one of saidplurality of instruments for selectively manipulating said at least oneinstrument relative to said shaft; an actuator engaged to said tip forselectively manipulating said tip relative to said shaft to expose acradle section; and an inflation port for selectively inflating saidballoon.